MEDICARE: CHRISTINE CHOI KIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	230156-1	NY
2	207N00000X	Dermatology Physician	A100588	CA

General Provider Information

NPI Number	:	1306827324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE CHOI KIM M.D.

Provider Business Mailing Address
First Line	:	11500 W OLYMPIC BLVD
Second Line	:	SUITE 480
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1524
Country	:	US
Telephone Number	:	310-477-4727
Fax Number	:

Provider Business Practice Location Address
First Line	:	11500 W OLYMPIC BLVD
Second Line	:	SUITE 480
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1524
Country	:	US
Telephone Number	:	310-477-4727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	03/21/2021

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